Insurance required for Femara prescription refill

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cp418
cp418 Member Posts: 7,079
edited June 2014 in Employment, Insurance, and Other Financial Issues

Well although I've been taking Femara for 5 years now the Pharmacy cannot refill my perscription unless approved by my insurance.  My oncologist wants me on extended AI coverage which I am happy to do.  So I'm wondering why now my insurance is holding up refill???  My company has a separate account which covers drugs - so my insurance only pays about 20% of the cost.  I explained to the pharmacy that I already cover any additional cost.

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  • BayouBabe
    BayouBabe Member Posts: 2,221
    edited July 2013

    I wonder if it is because the standard for Femara is still only 5 years? They may be dragging their feet and feeling it is not necessary, unlike the recommendation for tamoxifen for 10 years. Your oncologist may need to do some pushing on the insurance company for you.

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  • cheryl1946
    cheryl1946 Member Posts: 1,308
    edited July 2013

    The insurance company probably goes by the 5 yrs mentioned by BayouBabe. You may need to put in for a prior authorization. They send a fax to onc's office and onc gives reason for med and expedites the request.

    Good luck.

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  • cp418
    cp418 Member Posts: 7,079
    edited July 2013

    Thanks - yes I was wondering if that was the reason too even though many oncologists recommend "some patients" stay on AI longer.  Basically treat the individual patient and not the statistic.  I will pay myself if I must as I believe my oncologist has my best interest to stay healthy - - NOT the insurance company.

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  • cp418
    cp418 Member Posts: 7,079
    edited July 2013

    It appears insurance wants me to switch to the generic brand after they finally figured out I've been using Femara for years.....

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  • hbcheryl
    hbcheryl Member Posts: 5,113
    edited July 2013

    Insurance requirement is that when a generic becomes available that is what is given, the only way to get Femara is to have your doctor mark your prescription "No Generic" then you will get the Femara but I have been on Letrozole since it was introduced, I didn't notice any difference in the change over.

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